Helping Kids Cope With Grief

Candice uses puppets as part of the group sessions she has with the students. Photos by Melissa Donald

“When I tell people that I provide grief and loss counseling for children, they say, ‘How terrible.’ It’s not terrible at all. I come and talk to them during a difficult time in their lives,” says Candice Evans, a licensed clinical social worker and school-based grief counselor with Hosparus in Louisville.

“The students come together with their peers and share their stories of loss and what happened to the person who died. They learn about physical and emotional grief. They learn that it’s not all sad; they can be happy, especially when they have great memories about the person. They learn that people die for physical reasons. Grandma died of cancer and the doctors couldn’t help her any more. They are able to express their feelings and learn healthy coping skills (breathing exercises, mindfulness).”

Candice, 31, for a long time knew she would work with people; she shadowed a social worker in high school. In college, she took a course on death and dying and thought, “I’m okay with this.” She completed an internship at a hospice center in St. Louis and took a job working with families with individuals facing the end of life.

(Left) For the first therapy session, group members play Thumb Ball which requires a ball to be tossed from one person to another. After catching it, the member must read the question on the ball out loud and answer it.

“I thought it would be difficult for me to sit with families and not cry. I quickly learned that this work is good for me. I did a lot of growing up. Most of my clients were much older than me. I drew my strength from them, watching them face death with courage and grace at this fragile time in life.“I think the greatest gift and job responsibility was being able to sit with people. It’s more difficult than it sounds. They are in emotional distress and don’t know when the end will come. I offer listening and support in a nonjudgmental presence.”

After marrying and moving to Louisville in 2008 to get her master’s degree at the Kent School of Social Work at the University of Louisville, Candice began working at Hosparus in Louisville and eventually took over the school-based “Grief Relief” program for children. Because of donations, Hosparus is able to provide schools six weeks of counseling, one hour a week, for groups of five to eight kids.

Candice starts her sessions with the talking stick as a way of helping children feel more comfortable and secure as they share memories of their loved one.

“I ask the kids: Is it a choice to grieve? They say, ‘Yes, it is.’ But it isn’t. If you have a significant loss, you will grieve that loss. They can look like a normal kid, but they can also be sad and angry because their person died. It’s normal to allow yourself to feel.

“We open up group with saying your name, who died, and how you feel about coming to group today. They mostly say they are happy to come to group… because they have some place to come talk about it.”

Candice uses a sand tray and figurines for the final therapy session. One side of the sand tray memorializes the loved one who died and the other side shows three things that represent the child’s grief journey.

The counseling that Candice and other staff provide is developmental.

For children ages 4-7, death is seen as reversible. They often may feel responsible for the death because of thoughts or wishes. They may not understand that grandma died because of a heart attack and instead may think she died because “I said some angry things.” They can have repetitive questions about the death — how and why. Grief responses may include regression, sleeping and eating disturbances, and nightmares.

The children make inside/outside masks which gives them more insight into their emotions. The masks draw a distinction between the way the kids think they look on the outside and how they feel on the inside during the grieving process.

Children ages 7-11 see death as a punishment — for not being good or not doing something. They want details and might wonder, is something going to happen to Dad now that Mom has died? Grief responses may include regression, acting out, problems in school, sleep and eating disruption, and a desire to join the person who died.

Children paint rocks in colors representative of the person who died.

Children 12-18, have a more adult response: extreme sadness, regression, denial, anger, depression, and loneliness. They try to make sense of the death.There might be acting out, risk-taking, and seeking support through peers versus family.

(L-R) The children make memory voltives to honor their loved one; Candice creates a thumb print. Before the relative dies, the child can make a thumb print of the person’s thumb using a piece of sculpting clay. Candice bakes the piece of clay and gives it to the child after it hardens.

Here are Candice’s survival skills on helping children cope with grief and loss:Help children understand the four basic concepts of death so they can fully grieve and better understand what happened.

Death is irreversible. In movies, games, and television shows, characters “die” and come back to life. It’s important that children know that death is permanent.

All life functions end completely at the time of death. Children may be concerned about whether or not the person who died can feel or think. It might comfort them to know that when a person dies, they cannot move, breathe, think, or feel.

Everything that is alive eventually dies. Children, just as adults, struggle with the concept of death. Help children to understand that dying is a part of life for all living things, including plants, animals, insects, and people.

There are physical reasons why someone dies. Children who are not told how the person died may come up with their own explanation, which can cause guilt or shame.

Use concrete words to explain death to children. Adults often use phrases like “went to sleep” and “resting” to avoid frightening children. Use the words “died” and “dead” to avoid confusion. A child who is told the person is “sleeping” may become afraid to go to sleep, or they might watch the surviving parent as they sleep to make sure he or she doesn’t die.

Provide support over time. Not all children who have experienced a loss due to death need counseling, but all children who have experienced a loss due to death can benefit from education and a lifetime of support.

Demonstrate grieving by letting children see you cry, talking about the person who died, and seeking support.

Allow younger children to express themselves through normal play, drawing, looking at pictures. Younger and older children may benefit from being with peers and receiving support in a group setting.

Help children preserve memories (create a memory book) and create new ones through sharing of memories or rituals, such as lighting a candle in memory of the person who died.

Have you had to help your child through the grieving process? How did you do it?